Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Health Service Delivery Project (P099930) AFRICA | Mozambique | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2009 | Seq No: 20 | ARCHIVED on 03-Jan-2018 | ISR30697 | Implementing Agencies: MInistry of Health, Republic of Mozambique Key Dates Key Project Dates Bank Approval Date:16-Apr-2009 Effectiveness Date:11-Jun-2010 Planned Mid Term Review Date:15-Sep-2011 Actual Mid-Term Review Date:22-Jun-2012 Original Closing Date:28-Feb-2014 Revised Closing Date:31-Dec-2017 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project's development objectives are to: (a) reduce child mortality; (b) reduce maternal mortality; (c) reduce the burden of malaria; (d) reduce the prevalence of tuberculosis; and (e) reduce inequity in the access to health services in Mozambique. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)PHRPDODEL To increase access to, and utilization of, maternal and child health and nutrition services in target areas in the Recipient's territory. Components Name Improvement in service delivery.:(Cost $80.00 M) Boosting of national malaria control program:(Cost $15.50 M) Strategic Planning and Capacity Building:(Cost $7.40 M) Project Management and Operating Costs:(Cost $6.50 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Satisfactory 1/3/2018 Page 1 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Overall Risk Rating  Moderate  Substantial Implementation Status and Key Decisions The Mozambique Health Service Delivery Project was approved by the World Bank’s Executive Board on March, 20, 2009 and became effective on June 11, 2010. The project will close on December 31, 2017, and has disbursed 98.7% of the US$44.6 million original IDA credit, and 97.8% of the US$37 million additional financing credit, while all other co-financing trust funds have fully disbursed. Overall, key project indicators continue to progress well. The three provinces achieved a high rate of institutional delivery, an average of 92.5% between January to September 2017 from a targeted 90% at project closing on December 31, 2017. Similarly, the project has achieved its target with respect to the immunization of 97.3% of children 0-12 months with DPTHepHib3 in the target provinces from a targeted 90% between January and September 2017. In addition, the PDO indicator pertaining to the percentage of pregnant women receiving the second dose of IPT during antenatal care is close to being achieved at 70.3% from a targeted 78% for the first three quarters of 2017. The construction of all eighteen type II health centers has been completed in all three target Provinces: twelve in Niassa and Nampula, and all six in Cabo Delgado, including the three health centers that had been previously delayed. The project has sustained progress in implementation of Community Based Nutrition (CBN) interventions in all three provinces of Cabo Delgado, Nampula and Niassa, and activities have been rolled out in all 28 target districts. Community engagement in the implementation of CBN activities is high with involvement of various actors that have been mobilized and trained, including mother leader groups, health promoters, activists and community leaders. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Low  Substantial Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Low  Low Institutional Capacity for Implementation and Sustainability  --  Substantial  Substantial Fiduciary  --  Moderate  Substantial Environment and Social  --  Substantial  Substantial Stakeholders  --  Low  Low Other  --  --  -- Overall  --  Moderate  Substantial Results Project Development Objective Indicators 1/3/2018 Page 2 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) PHINDPDOTBL  Percentage of institutional deliveries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.80 89.60 92.50 90.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments Annual target for the final year of 90% for the project has been achieved. Dec 2017 figure of 92.5% is a weighted average of figures from three target provinces from the first three quarters of 2017 as follows: Cabo Delgado: 57,111/65,892 Nampula: 169,514/177,231 Niassa: 54,237/60,383 PHINDPDOTBL  Cabo Delgado (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 57.00 85.00 86.70 84.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Nampula (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 53.00 95.00 95.60 93.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Percentage of children vaccinated with DPTHepHib3 in the first year of life in each province (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 51.00 97.30 90.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 1/3/2018 Page 3 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Comments Annual target of 90% for the final year of the project has been achieved. Dec 2017 figure of 97.3% is a weighted average of figures from three target provinces from the first three quarters of 2017 as follows: Cabo Delgado: 52,156/58,570 Nampula: 153,603/157,539 Niassa: 56,792/53,674 (The estimated population of children 0-12 months as per census projections was underestimated in Niassa province, resulting in a higher coverage under this indicator (105.8%) relative to the estimated population). The figures from June 2017 were underestimated as incorrect denominators were used to calculate the percentage of children vaccinated, i.e. the number of target children aged 0-12 months for the year 2017 was used as the denominator for this annually estimated indicator, as opposed to six months (Jan-June 2017). PHINDPDOTBL  Cabo Delgado (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 71.00 45.00 89.00 90.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Nampula (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 52.00 97.50 90.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Percentage of pregnant women who received 2nd dose of IPT at antenatal clinics (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 79.00 70.30 78.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments Annual target of 90% for the final year of the project is nearly achieved. Dec 2017 figure of 70.3% is a weighted average of figures from three target provinces from the first three quarters of 2017 as follows: 1/3/2018 Page 4 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Cabo Delgado: 46,983/73,213 Nampula: 141,535/196,923 Niassa: 48,697/67,092. PHINDPDOTBL  Cabo Delgado (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 78.00 64.20 75.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Niassa (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 77.00 72.60 78.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Nampula (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 18.60 82.00 71.90 80.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDPDOTBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,895,994.00 2,542,703.00 1,030,100.00 Date 31-Dec-2013 30-Jun-2017 01-Dec-2017 31-Dec-2017 1/3/2018 Page 5 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Comments This indicator provides an annual snapshot of the total number of beneficiaries of the interventions conducted in the three target provinces among: (i) children 0-24 (beneficiaries of growth monitoring intervention used as proxy); (ii) pregnant women (IFA intervention used as proxy); and (iii) adolescent girls (IFA intervention used as proxy). The figures below report achievement since the last ISR: Cabo Delgado: 154,316 (Growth Monitoring among 0-24: 87,842 (Female – 46,408); IFA among pregnant women: 38,314; IFA among adolescent girls: 28,160) Nampula: 327,880 (Growth Monitoring among 0-24: 177,441 (Female – 94,043); IFA among pregnant women: 86,658; IFA among adolescent girls: 63,781) Niassa: 144,604 (Growth Monitoring among 0-24: 51,604 (Female – 26,834); IFA among pregnant women: 37,497; IFA among adolescent girls: 55,503) Total Number of Female Beneficiaries: 477,198 PHINDPDOTBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 76.10 80.00 PHINDPDOTBL  Percentage of children aged 0-24 months fed in accordance with all 3 IYCF practices (food diversity, feeding frequency, and consumption of breast milk or milk (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.01 25.70 24.50 24.00 Date 31-Dec-2013 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments The data from June 2017 of 25.7% represented an unweighted average of the baseline data collected by INS in 2013. The true weighted average from all three provinces of this indicator is actually 24.5% as reflected above. This comprises the 29.3% of children in Nampula fed in accordance with all three IYCF practices, followed by 24.5% in Cabo Delgado, and 23.2% in Niassa. It was originally envisaged that routine data for this indicator would be collected in all three provinces by the third-party providers using a similar methodology as the baseline (though not statistically representative), however, this has not taken place in all three provinces using a consistent methodology that would allow comparability across the three provinces in question. Overall Comments 1/3/2018 Page 6 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Intermediate Results Indicators PHINDIRITBL  Annual outreach visits to facilities in Cabo Delgado, Nampula, and Niassa (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,831.00 4,460.00 2,210.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments Number of outreach visits Jan-Sept 2017:Cabo Delgado - 560Nampula - 2255Niassa - 1645 PHINDIRITBL  Number of Agentes Polivalentes Elementares (APEs) trained (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,732.00 1,732.00 1,732.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments No additional training activities conducted. Total number of APEs trained remains at 1732 comprising:Cabo Delgado: 382Nampula: 718Niassa: 632 PHINDIRITBL  Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 374.00 796.00 374.00 Date 31-Dec-2009 30-Jun-2016 01-Dec-2017 31-Dec-2017 1/3/2018 Page 7 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) Comments Cumulative Number of health personnel trained:Cabo Delgado: -Nampula: 617Niassa: 179 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 18.00 18.00 Date 31-Dec-2009 31-Aug-2017 15-Dec-2017 31-Dec-2017 Comments All 18 health centers completed:Cabo Delgado: 6Nampula: 6Niassa: 6 PHINDIRITBL  Pregnant women receiving first ANC visit (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 165,917.00 290,940.00 426,271.00 593,000.00 Date 31-Dec-2009 30-Jun-2016 01-Dec-2017 31-Dec-2017 Comments The annual end target of 593,000 for this indicator is almost achieved. Number of pregnant women receiving first ANC visit between Jan- Sept 2017 is 426,271. 1/3/2018 Page 8 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) PHINDIRITBL  Cabo Delgado (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 118,126.00 65,005.00 93,040.00 121,000.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDIRITBL  Nampula (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 267,517.00 178,837.00 258,244.00 370,000.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDIRITBL  Children receiving a dose of vitamin A (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 194,521.00 1,048,705.00 1,225,930.00 1,385,200.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments The annual end target of 1,385,200 for this indicator is on track to being achieved. The number of children receiving a dose of vitamin A between Jan-Sept 2017 is 1,225,930. PHINDIRITBL  Cabo Delgado (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 178,490.00 130,009.00 194,034.00 314,000.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 1/3/2018 Page 9 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) PHINDIRITBL  Nampula (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 185,879.00 609,339.00 657,047.00 799,260.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDIRITBL  Number of children under 1 year of age fully immunized (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81,848.00 150,205.00 235,201.00 316,645.00 Date 31-Dec-2009 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments The annual end target of 316,645 for this indicator is almost achieved. The total number of children under 1 year fully immunized between Jan-Sept 2017 in three target provinces is 235,201. PHINDIRITBL  Cabo Delgado (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 62,412.00 28,219.00 46,301.00 69,527.00 Date 31-Dec-2012 30-Jun-2017 01-Dec-2017 31-Dec-2017 PHINDIRITBL  Nampula (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 150,427.00 92,505.00 139,475.00 184,320.00 Date 31-Dec-2012 30-Jun-2017 01-Dec-2017 31-Dec-2017 1/3/2018 Page 10 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) PHINDIRITBL  Number of Volunteers functional (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 28,888.00 19,700.00 21,000.00 Date 31-Mar-2013 30-Aug-2017 01-Dec-2017 31-Dec-2017 Comments Number of functional volunteers between Jan-Sept 2017:Cabo Delgado: 4861Nampula: 10,670Niassa: 4169 The number of functional volunteers appears to have been miscalculated in the previous ISR. PHINDIRITBL  Percentage of children aged 0-24 months attended at least 1 Growth Monitoring and Promotion services during the 2 preceding months,% who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52.60 35.40 80.00 Date 31-Mar-2013 31-Aug-2017 01-Dec-2017 31-Dec-2017 Comments Figures from Jan-Sept 2017 for three target provinces:a) Cabo Delgado: 87,842/102,498 (85.7%, F-46,408 or 45.3%)b) Nampula: 177,441/275,693 (64.4%, F-94,043 or 34.1%)c) Niassa: 51,604/93,929 (54.9%, F-26,834 or 28.6%) Aggregate: 67.1% (both sexes) or 35.4% female PHINDIRITBL  Percentage of children aged 6-24 months received at least 60 sachets of micronutrient powder (MNP) during the 2 preceding months, %who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.60 34.60 80.00 Date 31-Mar-2013 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments Disaggregations by gender are unavailable for all provinces for this indicator and therefore figures above represent both male and female beneficiaries (6-24 months) of the MNP intervention. Figures from Jan-Sept 2017 for three target provinces:a) Cabo Delgado: 22,911/102,498 (22.4%) (Approximately 55% Female)b) Nampula: 77,378/275,693 (28.1%) (Approximately 55% Female)c) Niassa: 62,987/93,929 (67.1%) (Approximately 71% Female) Aggregate: 34.6% (both sexes) 1/3/2018 Page 11 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) PHINDIRITBL  Percentage of pregnant women received a complete dose of IFA tablets (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 48.10 48.20 63.00 Date 31-Mar-2013 30-Jun-2017 01-Dec-2017 31-Dec-2017 Comments Figures from Jan-Sept 2017 for three target provinces:a) Cabo Delgado: 38,314/73,213 (52.3%)b) Nampula: 86,658/196,923 (44.0%)c) Niassa: 37,497/67,092 (55.9%) Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P099930 IDA-45820 Effective USD 44.60 44.60 0.00 43.16 0.57 97% P099930 IDA-51940 Effective USD 37.00 37.00 0.00 34.24 0.76 93% P099930 TF-58155 Closed USD 1.15 0.18 0.97 0.18 0.00 100% P099930 TF-96375 Closed USD 7.86 7.53 0.33 7.53 0.00 100% P099930 TF-96399 Closed USD 4.05 3.84 0.22 3.84 0.00 100% 1/3/2018 Page 12 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) P099930 TF-96505 Closed USD 12.80 12.34 0.46 14.02 0.00 114% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P099930 IDA-45820 Effective 16-Apr-2009 15-Jul-2009 11-Jun-2010 28-Feb-2014 31-Dec-2017 P099930 IDA-51940 Effective 24-Jan-2013 25-Mar-2013 21-Jun-2013 31-Dec-2016 31-Dec-2017 P099930 TF-58155 Closed 21-Sep-2007 21-Sep-2007 21-Sep-2007 31-Dec-2009 31-Dec-2009 P099930 TF-96375 Closed 19-Mar-2010 24-Mar-2010 24-Mar-2010 30-Apr-2013 31-Jul-2013 P099930 TF-96399 Closed 19-Mar-2010 24-Mar-2010 24-Mar-2010 28-Feb-2014 28-Feb-2016 P099930 TF-96505 Closed 15-Apr-2010 19-Apr-2010 19-Apr-2010 28-Feb-2014 31-Jan-2016 Cumulative Disbursements Restructuring History Level 2 Approved on 30-Dec-2016 Related Project(s) 1/3/2018 Page 13 of 14 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Service Delivery Project (P099930) P125477-Mozambique Nutrition Additional Financing 1/3/2018 Page 14 of 14 Public Disclosure Copy